On the side of the angels - 6/30/2005

Richard Humphries tells <b><i>Mark Ivory</i></b> he wants to push joined-up working in a friendly fashion as head of the Care Services Improvement Partnership. So what about his admiration for Gordon Ramsay?

Thursday 30 June 2005 00:00

Richard Humphries belongs to the dwindling band of advocates for social care in the Department of Health. As the first chief executive of the newly formed Care Services Improvement Partnership (CSIP), he will have a key role in shaping ministerial views of social care and in ensuring that government policy is implemented on the front line.

It was a difficult birth for CSIP, which brings together seven DH organisations responsible for a range of service development work in the field, including the National Institute for Mental Health in England (Nimhe) and the Valuing People support team (see panel, facing page). Humphries himself used to head another of the seven, the health and social care Change Agent team set up four years ago to help undo the logjam of delayed discharges from hospital.

Having initially decided to farm out CSIP to the Social Care Institute for Excellence, ministers went off the idea after the two sides fell out over plans for the new organisation with then community care minister Stephen Ladyman accusing Scie of having "blown" its chance. Instead it will stay within the DH with a brief to promote service improvement and joined-up approaches across social care and health.

Humphries has a long record of trying to bridge the divide between health and social care. Before his stint with the change agents, he headed social services and housing in Herefordshire while chief executive of the health authority, the first time the two roles had been combined.

It gave him the experience of complex organisational change which will be an important part of the new job.

With its £39m budget, CSIP will be more focused than its predecessors, he says. "It was becoming increasingly clear that the challenge of joined-up services needed joined-up support to enable service improvement." Initially at least, each partner will be funded at the previous levels - Nimhe's share is £24m - but the money will have to be used in a more cross-cutting way and priorities will change over time. The partnership will be regional, based in Nimhe's eight offices across the country.

Much attention will be on getting to grips with the adult green paper, where CSIP's role in helping providers and commissioners develop new models of care is highlighted. The history of social care is littered with supposedly seminal reports whose lofty ideals have never been realised in practice. This time, Humphries says, it will be different.

"In the past we've tended to produce policy and expect people to get on with it. The whole point of CSIP is to roll our sleeves up and help people make it work. We want to anticipate problems before they become crises - all too often people are too far down the curve before they get help."

He insists that CSIP won't be a posse of government bullies sent in to sort out errant services - even the term "task force" is too strong for his taste. "I wouldn't use that phrase because it has the slight smack of hit squad and that is emphatically what we're not," he says. "A support force, yes, but definitely not a hit squad. We want to be on the side of the angels."

But what about the slow developers? "Did you see Gordon Ramsay last night? The thing about Ramsay is that he rolls up his sleeves and helps - he doesn't just bollock them out of sadistic pleasure, he does it because he wants them to change.

"I'd like to think that we'd challenge in a friendly way when we think that people need to gee themselves up a bit. I'd have welcomed that in the past; I think we all need a bit of a prod and sometimes a kick because it's so easy to get complacent."

Whether administered by angels or would-be Gordon Ramsays, the litmus test used by the 300-plus CSIP staff from a variety of health and social care backgrounds will be "would this service be good enough for me or my family to use?" The question of how the necessary service improvements are to be funded will have to be publicly debated, Humphries says, but the answer may lie in the wealthier society and the growing social expectations which give rise to the question in the first place. "The tectonic plates are shifting; we're starting to get a whole new generation of older people who will be more affluent and we get into issues such as co-payment. I don't think it's as simple as saying 'if only the government would spend more on social care'."

CSIP's panoptic vision goes beyond the green paper, extending to the public health white paper and its emphasis on well-being and prevention, bringing the various national service frameworks to bear and embracing the "huge policy agenda" for mental health, mental capacity and long-term conditions. It will also be working with local authorities on the Gershon efficiency savings, helping to achieve, in Humphries' words, the "right relationship" between needs and resources.

Inevitably, ideas about "what works", both new and imported from other localities, will be highly prized and Humphries hopes that social care agencies will help to road-test some of them. Individual budgets, connected care centres and self-assessment will be among the early themes.

No part of the government's welfare reform programme would be complete without talk of choice. The abysmal performance on direct payments - fewer than 20,000 recipients after eight years of availability - will be tackled, although Humphries is clear that this will produce choice for service users only if the independent sector is supported to diversify what it has to offer them.

"We've got to balance our efforts on promoting individual budgets with developing capacity and making the workforce fit for purpose. And we've got to make it much easier for people to access services and set up their own care arrangements without a bureaucratic quagmire."

Since his mission is to cut red tape rather than increase it, Humphries is sensitive to claims that he's just adding to the regulatory paperwork. He believes that CSIP's distinctive contribution will be practical programmes of support which organisations such as the Commission for Social Care Inspection aren't necessarily best placed to provide. "We're not performance managers, we're not regulators, so that means we can concentrate our energies on what needs to be done," he says.

Difficult decisions will have to be taken about the role of social care professionals. If users have more choice and the right to take risks, where does this leave social workers who have a duty of protection? Won't they be blamed whenever things go wrong? "I think we've got to write into agreements what the role of the worker is and where their responsibilities begin and end," says Humphries. "It's not enough to say, 'don't worry, it'll be all right if anything goes wrong' - if I were a social worker I wouldn't be happy about that. I'd like to invest some time in some smart thinking about how we clarify the responsibilities that go with the choices that people make."

The green paper conjures up a seeming utopia in which social workers cease to be "gatekeepers" blocking the way to services and become "navigators" helping users get what they need. For Humphries it is "entirely appropriate" to consider the similarities between navigators and independent financial advisers, putting together the packages best suited to individual clients.

He would like to see more social care professionals working in primary care and education settings, but he claims not to be particularly wedded to structural integration between health and social care. Social care should be more about values than structures, he says, although he doesn't disguise his dislike of what he calls the "municipal model". "Social care has not been helped by being overly associated with the local authority," he says.

"It's very much about allowing a thousand flowers to bloom in social care. We've got to cultivate a few of them so that we will meet the preferences of a whole new generation of people who simply won't be content with what the local council can do for them. They'll vote with their feet and their wallets unless we deliver."

Partners for improvement
The Care Services Improvement Partnership comprises: